Resource and Cost Adjustment in the Design of Allocation Funding Formulas in Public Health Programs

Buehler, James W.; Bernet, Patrick; Ogden, Lydia L.

doi:10.1097/phh.0b013e3182431da6

Cited by 3 publications

(6 citation statements)

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“…This observation illustrates a key attribute of the PA value: although there is a general inverse relationship between salary costs and wealth, 11 meaning that salary and wealth adjustments would have counterbalancing effects on statespecific allocations, adjustments using these salary and 2 wealth adjustments result in comparable PA values. In other words, the overall degree of dispersion from equity funding resulting from these 3 adjustments as measured by the per-capita PA value is comparable, and the PA value provides no indication of differences in the direction of state-specific dispersion that results from alternative adjustments.…”

Section: Table 1 • Percentage Of Allocation Shifted and Per-capita Anmentioning

confidence: 87%

“…Thus, when comparing different allocations, the PA value should be considered in tandem with other allocation metrics, such as the number of states with relatively large increases or decreases in funding. 11 Referent allocations provide a basis for characterizing allocations but do not predict whether one allocation is more likely than another to result in achievement of program objectives. For example, when programs dedicate a proportion of total funding to equal minimum funding for all states, allocation distributions are more disproportionate than either the per-capita or poverty referents, an effect that increases as the proportion of total funding dedicated to equal minimum allotment increases.…”

Section: • Discussionmentioning

confidence: 99%

“…We also considered allocations adjusted for variations among states in salary costs, the availability of in-state revenues, and income disparities, as previously described. 11 For an individual state, an adjustment for higher salary costs and greater levels of income disparity would result in an increased allocation share, an adjustment for higher availability of in-state resources subject to potential taxation would result in lower allocation shares, and vice versa (see Table 1). Adjustors for salary costs and per-capita income are inversely correlated (r = −0.865), and adjustors for per-capita aggregate home values and percapita income are strongly correlated (r = 0.832).…”

Section: • Methodsmentioning

confidence: 98%

“…Adjustors for salary costs and per-capita income are inversely correlated (r = −0.865), and adjustors for per-capita aggregate home values and percapita income are strongly correlated (r = 0.832). 11 The 3 hypothetical program allocations and 1 actual program allocation were as follows.…”

Section: • Methodsmentioning

confidence: 99%

“…11 In this article, we explore the use of an additional evaluation measure-a descriptor of allocation inequalities derived from the Gini index 12 -to characterize allocations resulting from different funding formula designs. This measure, which we term the "proportionality of allocation" (PA), illustrates the sum of differences between a given allocation and the 2 referent allocations.…”

mentioning

confidence: 99%

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Reference Allocations and Use of a Disparity Measure to Inform the Design of Allocation Funding Formulas in Public Health Programs

Buehler

Bernet

Ogden

2012

Journal of Public Health Management and Practice

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Funding formulas are commonly used by federal agencies to allocate program funds to states. As one approach to evaluating differences in allocations resulting from alternative formula calculations, we propose the use of a measure derived from the Gini index to summarize differences in allocations relative to 2 referent allocations: one based on equal per-capita funding across states and another based on equal funding per person living in poverty, which we define as the "proportionality of allocation" (PA). These referents reflect underlying values that often shape formula-based allocations for public health programs. The size of state populations serves as a general proxy for the amount of funding needed to support programs across states. While the size of state populations living in poverty is correlated with overall population size, allocations based on states' shares of the national population living in poverty reflect variations in funding need shaped by the association between poverty and multiple adverse health outcomes. The PA measure is a summary of the degree of dispersion in state-specific allocations relative to the referent allocations and provides a quick assessment of the impact of selecting alternative funding formula designs. We illustrate the PA values by adjusting a sample allocation, using various measures of the salary costs and in-state wealth, which might modulate states' needs for federal funding.

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Section: Table 1 • Percentage Of Allocation Shifted and Per-capita Anmentioning

confidence: 87%

Section: • Discussionmentioning

confidence: 99%

Section: • Methodsmentioning

confidence: 98%

Section: • Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Reference Allocations and Use of a Disparity Measure to Inform the Design of Allocation Funding Formulas in Public Health Programs

Buehler

Bernet

Ogden

2012

Journal of Public Health Management and Practice

Self Cite

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HIV prevention where it is needed most: comparison of strategies for the geographical allocation of interventions

et al. 2017

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IntroductionA strategic approach to the application of HIV prevention interventions is a core component of the UNAIDS Fast Track strategy to end the HIV epidemic by 2030. Central to these plans is a focus on high‐prevalence geographies, in a bid to target resources to those in greatest need and maximize the reduction in new infections. Whilst this idea of geographical prioritization has the potential to improve efficiency, it is unclear how it should be implemented in practice. There are a range of prevention interventions which can be applied differentially across risk groups and locations, making allocation decisions complex. Here, we use mathematical modelling to compare the impact (infections averted) of a number of different approaches to the implementation of geographical prioritization of prevention interventions, similar to those emerging in policy and practice, across a range of prevention budgets.MethodsWe use geographically specific mathematical models of the epidemic and response in 48 counties and major cities of Kenya to project the impact of the different geographical prioritization approaches. We compare the geographical allocation strategies with a nationally uniform approach under which the same interventions must be applied across all modelled locations.ResultsWe find that the most extreme geographical prioritization strategy, which focuses resources exclusively to high‐prevalence locations, may substantially restrict impact (41% fewer infections averted) compared to a nationally uniform approach, as opportunities for highly effective interventions for high‐risk populations in lower‐prevalence areas are missed. Other geographical allocation approaches, which intensify efforts in higher‐prevalence areas whilst maintaining a minimum package of cost‐effective interventions everywhere, consistently improve impact at all budget levels. Such strategies balance the need for greater investment in locations with the largest epidemics whilst ensuring higher‐risk groups in lower‐priority locations are provided with cost‐effective interventions.ConclusionsOur findings serve as a warning to not be too selective in the application of prevention strategies. Further research is needed to understand how decision‐makers can find the right balance between the choice of interventions, focus on high‐risk populations, and geographical targeting to ensure the greatest impact of HIV prevention.

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Ticket utilization and implementation: Investigating use patterns of the Ticket to Work program from the consumer’s perspective

Hanson

Dillahunt-Aspillaga

Smith

2019

JVR

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BACKGROUND:The Ticket to Work Incentives and Improvement Act provides work incentives for Social Security Administration (SSA) beneficiaries with various disabilities. Of the 9,963,114 tickets "rolled" out, approximately 64,000 Tickets were used. The small amount utilized indicated a further need to investigate individual Ticket usage. OBJECTIVE: This article takes a policy perspective, exploring and discussing personal experiences of Supplemental Security Income beneficiaries who received a "Ticket to Work" in 2003. METHODS: A small pilot survey was administered to five beneficiaries. A close read of the responses in concert with a discursive approach was conducted to determine additional factors that may play a role in the participants' decisions to use their Tickets. RESULTS: Participants were overwhelmed with the amount of information provided in the Ticket packages and perceived disincentives (e.g., loss of existing health care and disability benefits) to act on their Tickets. CONCLUSIONS: Considering the ambiguity expressed by the participants, customized employment may be a viable solution to reduce load on agencies and increase participation in Federal programs. From a policy perspective, this study illustrates the value of small pilot studies and first-person accounts to determine participants' ability to understand complex activities and to decide to act. It also reinforces the importance of consumer-led input into long-term support programs.

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Resource and Cost Adjustment in the Design of Allocation Funding Formulas in Public Health Programs

Abstract: Selection of adjustors for formula-based funding allocations should consider the impacts of different adjustments, correlations between adjustors and other data elements in funding formulas, and the relationship of formula inputs to program objectives.

Cited by 3 publications

References 21 publications

Reference Allocations and Use of a Disparity Measure to Inform the Design of Allocation Funding Formulas in Public Health Programs

Reference Allocations and Use of a Disparity Measure to Inform the Design of Allocation Funding Formulas in Public Health Programs

HIV prevention where it is needed most: comparison of strategies for the geographical allocation of interventions

Ticket utilization and implementation: Investigating use patterns of the Ticket to Work program from the consumer’s perspective

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